Clinical Case Research Articles

Randomized controlled trial parallel-group on optimizing community pharmacist's care for the elderly: The influence of WhatsApp-Email delivered clinical case scenarios.

Drug-related problems (DRPs) significantly threaten the safety of the elderly. In order to improve pharmacists' ability to minimize these events, novel educational interventions that consider the current challenges in clinical practice are crucial. The primary objective is to assess the impact of two unique educational interventions on pharmacists' ability to identify DRPs. A total of 127 community pharmacies in the United Arab Emirates (UAE) were recruited and randomly allocated to one of three arms using a 1:1:1 allocation ratio. While a series of clinical case scenarios (N = 24) related to elderly care were established and validated and sent to pharmacists in Active Group A over a 3-month period, lengthy research articles focused on medication safety in elderly were emailed to pharmacists in Active Group B. The control group pharmacist received no intervention. Then, pharmacists self-reported the number, categories, and severity of DRPs and pharmacist recommendations. The incidence of DRPs identified by pharmacists was 10.8% in Active Group A, 2.0% in the Control Group (p = 0.011), and 3.8% in Active Group B (p = 0.014). A significant difference was observed in the proportion of DRP types between Active Group A and the Control Group. The most common DRPs in Active Group A were avoidable medication (14.7%) and untreated disease (9.2%). Pharmacists in Active Group A (37.2%) and Active Group B (32.3%) most commonly intervened by recommending the cessation of medication, while the most common intervention in the Control Group was recommending a decrease in dose (29.8%). The mean cost reduction per patient was highest in Active Group A (31.3 ±11.8 $), followed by Active Group B (20.8 ±8.6 $) and the Control Group (19.6 ±9.5 $). The mean time needed to resolve a DRP was shortest in Active Group A (7.3 ±3.5 minutes), followed by Active Group B (9.8 ±4.2 minutes) and the Control Group (9.8 ±5.7 minutes). Using WhatsApp to deliver clinical scenarios was effective in improving pharmacists' ability to identify and address DRPs in elderly patients, resulting in faster resolution and higher cost savings.

DENTAL MANAGEMENT IN PATIENTS WITH SYNDROMIC CRANIOSYNOSTOSIS; CASE REPORT

Introduction: Apert syndrome is a challenging syndromic condition for health care specialists because it affects the patient's overall physical, oral and behavioral health. Knowledge of the protocols to be followed and dental management by the operator of patients with AS are of great importance in the dental field, allowing for adequate and guided craniofacial and behavioral control of the patient. Objective: The objective of this article is to present a clinical case that shows an adequate treatment plan for a patient with Apert syndrome. Methodology: an objective description of the clinical case is made with analysis of a total of articles, including review and original articles, as well as clinical cases, of which 12 bibliographies were used because the other articles were not relevant for this study. The sources of information were indexed journals, as well as search engines such as PubMed, Google Scholar and Cochrane; the terms used for the information search were: Apert syndrome, acrocephalosyndactyly, craniosynostosis, dental care. Results: We report a 15-year-old female patient who presented the characteristic triad of Apert syndrome: craniosynostosis, facial malformations and symmetrical syndactyly. Conclusions: Knowledge of the disease by health professionals will be of vital importance in order to develop appropriate strategies and efficient care protocols for patients with Apert syndrome, resulting in a better quality of life for the patient in the short and long term. KEY WORDS: acrocephalosyndactyly, craniosynostosis, dental care.

Type I Branchial Cyst of the Sedunda Cleft Uncommon presentation: Case Report

Introduction: The cyst branchial is a rare tumor as well known as cysts lymphoepithelial, are dysembryological rare and benign second cleft tumors. Tumors cystic that HE develop in the part anterolateral of the neck; represent he 2% of the tumors laterocervical of the neck [1]. Clinical Case: We present he clinical case of a patient male of 37 years, does not report personal pathological history, with a clinical picture of approximately 8 months of evolution approximately characterized by a laterocervical tumor right with progressive growth in size, not accompanied by any other symptoms. Upon examination Physical: A mobile, fluctuating tumor of approximately 5 cm in diameter is observed in the right cervical region III, with no changes in skin color. No symptoms of a sinus or fistulous tract are observed. Discussion: The cyst branchial is a rare tumor and benign second cleft tumors. Tumors cystic that HE develop in the part anterolateral of the neck, represent he 2% of the tumors laterocervical of the neck, proper physical examination determines its prompt diagnosis and surgical treatment [6]. Conclusion: In conclusion, despite their low incidence, third branchial cleft cysts should be included in the differential diagnosis of laterocervical tumors. An adequate history and physical examination, complemented by the indicated imaging tests, will allow establishing a presumptive diagnosis that should be confirmed histologically after surgical resection.

Psoriasis: a disease beyond the skin.

Psoriasis is a chronic, immune-mediated inflammatory dermatosis with a multifactorial etiology, affecting approximately 3% of the Italian population. This condition not only imposes a substantial burden on physical health but also significantly diminishes the personal and social quality of life of affected individuals. This study aims to assess the critical role of integrated management approaches in psoriasis, focusing specifically on the role of primary care physicians in coordinating multidisciplinary care and addressing comorbidities. A comprehensive review of current therapeutic guidelines, classification systems, and available treatment strategies was conducted. This was supplemented with real-world clinical case studies. The study evaluated intervention approaches at both primary and secondary care levels, involving collaborations between general practitioners and specialists. Special emphasis was placed on the use of clinical assessment tools such as the Psoriasis Area and Severity Index (PASI) to categorize disease severity and guide therapeutic decisions. Our findings underscore the effectiveness of a multidisciplinary and personalized approach in managing psoriasis, particularly in moderate-to-severe cases. The pivotal role of primary care physicians in the early diagnosis, ongoing monitoring, and coordination of care pathways was highlighted, leading to significant improvements in comorbidity management. The clinical cases presented illustrate how tailored therapeutic regimens, supported by close collaboration between general practitioners and dermatologists, can result in the effective resolution of psoriatic lesions and markedly enhance patients’ quality of life. This study reinforces the necessity of a comprehensive, integrated, and multidisciplinary approach in the management of psoriasis, with primary care physicians serving as crucial intermediaries between community-based and specialist care. Depending on disease severity, treatment response, and recurrence patterns, primary care physicians play a central role in directing patients to appropriate secondary care services. The integration of specialist dermatological care with ongoing community-based monitoring optimizes clinical outcomes and mitigates the overall disease burden. We advocate for the establishment of clinical networks that facilitate seamless communication between different levels of care, ensuring holistic and targeted management of both psoriasis and its associated comorbidities. Keywords: Psoriasis, primary care physician, multidisciplinary care, integrated therapy, quality of life, comorbidities.

Antimicrobial Prescription Practices and Stewardship in Washington State Small and Mixed Animal Veterinary Medicine.

Judicious antimicrobial use is essential for the continued treatment of infections in small and mixed animal veterinary medicine. To better support Washington (WA) State veterinarians in antimicrobial stewardship, we surveyed licensed small and mixed animal veterinarians and led group conversations regarding antimicrobial prescription practices. Survey questions included demographic information, factors influencing prescription practices and clinical cases. Responses were summarised and logistic regressions were performed to identify factors associated with antibiotic treatment choices. Group conversations, led by a licensed veterinarian, focused on resource gaps for veterinarians, management of clinical scenarios and interpretation of minimum inhibitory concentrations (MICs) and breakpoints. A systematic qualitative analysis of conversation transcripts identified key themes such as common barriers to stewardship. Among 53 responses to clinical scenarios, veterinarians selected the most appropriate treatment choice, according to a veterinary microbiologist, 62% of the time. Variability was observed in culture and susceptibility practices and antibiotic choices. Survey respondents reported an influence of the client ability to medicate (92%), considerations of resistance (91%), client finances (75%) and availability of antimicrobials (75%) on their prescription decisions. There were no significant associations between opinions about contributing factors to antimicrobial resistance (AMR) or guidelines used and treatment choices in clinical scenarios. Among 15 veterinarians interviewed in group conversations, a systematic qualitative analysis of conversation transcripts revealed key themes, including reliance on human medicine as a resource and a lack of support for veterinarians in interpreting MICs and breakpoints. The variability in veterinary antibiotic treatment decisions in this study suggests a need for further dissemination of standardised antimicrobial stewardship resources for veterinarians. Client-related challenges and the cost of culture and susceptibility are major barriers to stewardship. To address these barriers, it is necessary to provide standardised, easy-to-access guidance for veterinarians in interpreting MICs and breakpoints, as well as develop antimicrobial use resources for clients.

A case report on renal metastasis as an unusual presentation of choriocarcinoma

BackgroundChoriocarcinoma is an aggressively invasive neoplasm, characterized by its rapid proliferation and propensity for metastasis to distant organs via hematogenous dissemination. Lungs (80%), vagina (30%), pelvis (20%), liver (10%), and brain (10%) are the most frequently metastasized organs. Renal metastases are very rare. The clinical manifestations of choriocarcinoma varies depending on the site of disease, making diagnosis challenging. In this report, we provide a clinical case of choriocarcinoma with metastases to the renal and pulmonary systems, displaying symptoms akin to those observed in ectopic pregnancy.Case presentationA 27-year-old female, G2P1, with a previous history of full-term pregnancy in 2018, presented to the hospital with the onset of vaginal bleeding and accompanying abdominal aches. Investigations uncovered a left adnexal mass with a human chorionic gonadotropin (hCG) level of 77,4 mIU/mL and a left pulmonary nodule measuring 31 mm x 21 mm. Laparoscopy was performed due to the high suspicion of an ectopic pregnancy. However, no visible villi were identified during the surgery, and postoperative blood hCG levels continued to rise. A diagnostic curettage also failed to reveal any villi, maintaining the suspicion of a persistent ectopic pregnancy. Following two ineffective courses of methotrexate therapy, the patient was referred to our facility. Prior to her referral, an ultrasound had indicated a mass in the right kidney. However, upon arrival at our hospital, subsequent ultrasonography failed to detect any renal masses. Despite two months of outpatient monitoring, there was a sudden and significant increase in her serum hCG levels. An emergency laparoscopy was performed, revealing no pregnancy-related lesion. After surgery, the patient’s hCG levels dropped dramatically to less than one-tenth of the original amount. Multisite enhanced computed tomography(CT)revealed suspicious lesions in both the renal and pulmonary regions. Upon thorough multidisciplinary consultation, a diagnosis of choriocarcinoma was entertained. Consequently, the patient successfully underwent eight cycles of chemotherapy and has remained recurrence-free for the past year.ConclusionsThis case underscores the potential for choriocarcinoma in women of reproductive age who exhibit radiological signs of renal masses. Early and accurate diagnosis, followed by prompt intervention, is essential to prevent needless surgery procedures.

CORONARY OPENING USING THE BASTIEN TECHNIQUE IN THE LEFT LOWER FIRST PREMOLAR – CASE REPORT

This study aims to present a clinical case in which the first lower left premolar (34) was opened using the Bastien technique. The intraoral clinical examination revealed extensive caries on the vestibular surface. The radiographic findings showed the presence of a radiolucent area in the cervical third and an increase in the periodontal ligament space. The instruments recommended for root canal preparation were: Prodesign Logic 30.05. The obturation was performed using the single cone technique associated with BIO-C Sealer (Angelus) cement and the vestibular wall was restored with Opus bulk fill flow (FGM) composite resin. It is concluded that the treatment with modified access using the Bastien technique, performed on a lower premolar with caries on the vestibular surface, preserves the healthy coronal dentin, resulting in clinical and radiographic success, which may represent an advantage in relation to dental longevity.

Treatment of patients with periprosthetic infection and management of Paprosky type 2C cavitary defects at the stage of articulating spacer installation

Introduction Due to the constant increase in the number of primary and revision hip arthroplasties, the incidence of complications has been also increasing. Periprosthetic joint infection (PJI) is the most common and dangerous complication in joint arthroplasty, including PJI with cavitary defects of the acetabulum (Paprosky type 2C).The purpose of the work was to demonstrate successful results of managing acetabular defects in patients with periprosthetic infection at the stage of installing an articulating spacer.Materials and methods The patients underwent surgical management of cavitary defects of the acetabulum with allobone plastic material at the stage of installation of an articulating spacer impregnated with antibacterial drugs. A clinical and functional assessment of the effectiveness of treatment of patients with PJI of the hip joint, who underwent bone grafting of acetabular defects at the first stage of two-stage revision arthroplasty, was carried out. Remission of the infectious process was assessed according to the ICM 2013 (International Consensus Meeting), and the function of the affected limb was assessed according to the HHS (Harris Hip Score).Results At a 6-month follow-up after implantation, there were no clinical and laboratory manifestations of PJI and radiological signs of instability of the implant components. Bone grafting was evaluated to be satisfactory; the function of the affected joint restored to 80–90 to HHS points. Remission of the infectious process according to ICM was achieved.Discussion Clinical cases studied demonstrate a positive result of treatin PJI with plastic surgery of cavitary defects of the acetabular bottom at the stage of articulating spacer installation. Filling acetabular defects at the sanitizing stage (implantation of a spacer) subsequently provides improvement of primary fixation and osseointegration of the acetabular component when converting the spacer to a permanent implant. This is due to an increase in the contact area of the acetabular component with bone tissue (native bone and remodeled allobone material).Conclusion The treatment of the first clinical case improved joint function from 24 to 85 HHS points, and in the second from 27 to 76 HHS points. The use of defect filling techniques enabled to stop the infection and improve functional results.

Computed tomography of the equine caudal spine and pelvis. Pathological findings in 56 clinical cases (2018-2023).

Computed tomography (CT) of the axial skeleton is increasing across many equine hospitals. CT of the pelvis and caudal spine in a large group of clinical cases has not been reported previously. To describe the pathological lesions identified in the caudal spine/pelvis in horses and ponies undergoing CT spine of this region. A retrospective case series. Horses with CT imaging of the caudal spine/pelvis were included. Horses aged under 6 months and those with CT examinations performed post-mortem were excluded. Fifty-six horses met the inclusion criteria. Ages ranged from 8 months to 20 years and bodyweights from 85 to 680 kg (mean 488 kg). Horses presented predominantly for lameness (30/56) and poor performance (18/56). Osseous pathology was identified in 41/56 horses; including osteoarthritis of the sacroiliac joint(s) (n: 28), pathology of the intervertebral disc joint(s) (n: 12), pelvic fractures (n: 9), osteoarthritis of the coxofemoral joint(s) (n: 8), ventral spondylosis (n: 6), acetabular rim fracture (n: 2), dislocation of coxofemoral joint(s) (n: 2), and dorsal dermal sinus of the sacrum (n: 1). The relationship between CT imaging findings and clinical signs in horses remains unclear. Further work is required to describe the relationship between congenital, developmental, and acquired changes in the caudal spine and pelvis, and clinical signs. CT of the caudal spine and pelvis can be utilised in horses and ponies for diagnosing a range of clinical disorders that may be causing 'lumbosacroiliac pain', poor performance, hindlimb lameness, and stiffness. The pathologies we observed were diverse and many patients had multiple lesions.

Talar head replacement for treatment of Müller – Weiss syndrome: three clinical cases

Introduction Müller – Weiss syndrome is a rare condition that is characterized by avascular necrosis of the navicular bone leading to severe foot deformity, pain disturbing activities of daily living. There is no generally accepted treatment for avascular necrosis of the scaphoid, and the available treatments have disadvantages, which necessitates the need for new options.The objective was to present short-term results of three patients with osteonecrosis of the scaphoid and local necrosis of the talar head treated with ceramic talar head prosthesis, plastic surgery, metal osteosynthesis of the scaphoid and related surgical techniques.Material and methods Three patients diagnosed with Müller – Weiss syndrome were treated with ceramic talar head replacement, autologous bone grafting and metal osteosynthesis of the scaphoid bone with accompanying surgical techniques. Severity of pain and the condition of patients were assessed with the VAS and AOFAS AH scores.Results Short-term results showed consolidation at the site of metal osteosynthesis in all patients with no signs of instability of the talus hemiprosthesis. VAS and AOFAS AH scores indicated decrease in the pain and improved condition of the patients.Discussion Hemiarthroplasty of the talar head combined with plastic surgery and restoration of a congruent joint surface of the scaphoid, and associated surgical techniques may become an effective alternative to existing treatments for patients with Müller – Weiss syndrome, with further study.Conclusion The short-term findings showed that hemiarthroplasty was practical for restoration of the talonavicular mobility maintaining stable fixation of the talus.

Clinical case of a live-born child with triploidy

Theoretical data on etiopathogenesis, clinical manifestations of triploidy, life expectancy of children in case of live-birth with this chromosomal anomaly are presented. A clinical case of a triploidy in a child is described. The girl was born from the first pregnancy from young healthy parents. Parents are not close relatives. Pregnancy was complicated with anemia, recurrent threats of miscarriage, progressive lack of water, progressive violation of uteroplacental blood flow and delay in fetal development. A congenital heart defect was diagnosed prenatally. The girl was born at 38 weeks of pregnancy with low indicators of physical development by caesarean section. Multiple developmental anomalies and malformations were revealed after birth. Combined congenital heart disease was confirmed by instrumental examination. Karyotyping revealed karyotype 69, ХХХ. Dynamic observation revealed that the child's age-related skills were not formed. Epileptic seizures occurred from the age of 4 months. The seizures had a status course. Surgical correction of congenital heart disease was performed in two stages: at 4.5 months and at 9.5 months in this patient. A fatal outcome occurred with an increase in multiple organ failure at the age of 10 months. The features of the clinical case, the possibilities of prenatal diagnosis of triploidy are analyzed.

Characterization, Antibiotic Susceptibility, and Clonal Analysis of Carbapenem-Resistant Klebsiella pneumoniae From Different Clinical Cases

Characterization, Antibiotic Susceptibility, and Clonal Analysis of Carbapenem-Resistant Klebsiella pneumoniae From Different Clinical Cases

Ischemic stroke due to dissection of the posterior cerebral artery in a patient with polycystic kidney disease

Polycystic kidney disease (PKD) is a genetic condition clinically manifested by the formation of multiple cysts in the kidneys, liver and pancreas, as well as cardiovascular pathology. One of the rare complications of PKD is the development of dissections of the aorta, coronary and cerebral arteries.This article presents a clinical case of ischemic stroke due to dissection of the posterior cerebral artery in a young patient with PKD who had a history of recurrent bleeding in the deep parts of both cerebral hemispheres.

Mesenchymal tumors of the mediastinum: analysis of the clinical case

Mediastinal tumors include a wide range of benign and malignant neoplasms. The latter in the early stages are characterized by a long latent course and carry a significant threat of com pression and / or invasion of vital organs of the mediastinum. The complexity of their diagnosis is complemented by a mixed clinical picture, similar to other somatic diseases. Considering all of the above, mediastinal tumors are an urgent problem for the modem oncological community, they require improving knowledge and gaining experience in their surgical and conservative treatment. Mesenchym al tumors of the mediastinum make up a small part of tumors of the mediastinal space, and the low incidence of neoplasm s of this anatomical localization dictates the need for an interdisciplinary approach to the diagnosis and treatment of mesenchym al tumors of the mediastinal space. A clinical case of the disease is considered, an effective and radical surgical treatment method is demonstrated. The asymptomatic course of the early stages of the disease, as w ell as the relatively low effectiveness of surgical intervention in the late period of oncogenesis, dictates the need to search for new approaches in the diagnosis and treatment of mediastinal tumors.

Target neonatal echocardiography as efficiency assessment method of shock therapy in newborns (a series of clinical observations)

The objective was to demonstrate clinical cases of shock therapy in newborns under the control of target neonatal echocardiography. This method of hemodynamic monitoring is performed at the bedside by intensive care physicians and is available around the clock.Materials and methods. The article describes three clinical cases of shock in newborns whose hemodynamic status was assessed by target neonatal echocardiography.Results. The use of target neonatal echocardiography made it possible to identify a disturbed component of hemodynamics (preload, contractility, postload). In some cases, the actual hemodynamic status differs from the hypothetical one. This made it possible to carry out targeted hemodynamic management and prevent pathogenetically unjustified therapy with potential iatrogenic complications.Conclusion. Target neonatal echocardiography has demonstrated its clinical effectiveness in bedside assessment of hemodynamics in critically ill newborns.

Tratamento endodôntico em dentes decíduos associado à reabilitação oral estética e funcional: relato de caso

Pediatric dentistry is an area within dentistry dedicated to oral health care for babies, children and even teenagers. The main focus of this specialty, as well as the focus of this work, is to promote awareness about the importance of creating healthy habits for children and maintaining the deciduous tooth in the alveolus until it is naturally replaced by permanent teeth. Endodontic treatment is usually proposed for two main causes: caries and dental trauma, which is very common in early childhood. The objective of this work was to carry out an endodontic treatment in deciduous teeth (51 and 61) and subsequent aesthetic rehabilitation of elements 51, 61, 52, 62 with composite resin. It can be concluded that the rehabilitation of the anterior deciduous teeth was extremely important from the aesthetic, functional and psychological point of view of the child. The use of maneuvers such as endodontics in deciduous teeth as well as the association of restorations with composite resins became a viable alternative in this clinical case, allowing the reestablishment of form, function and aesthetics.

Overcoming Barriers: Diagnosis of High-Grade Melanoma: Perspective from a Clinical Case

We present the case of a 30-year-old male patient with loss of visual acuity in the left eye. The imaging study detected a lesion of high suspicion of tumor in the left eye. Enucleation of the left eye was performed, confirming the diagnosis of choroidal melanoma by histopathological study. Subsequently, the disease progressed with neoplastic activity in the lungs, liver, lymph nodes and central nervous system. A case description is provided along with a bibliographic review, focusing on the approach and prognostic factors in patients with metastatic disease.

The Diagnostic Challenges of Late-onset Neuropsychiatric Symptoms and Early-onset Dementia: A Clinical and Neuropathological Case Study

The emergence of new-onset neuropsychiatric symptoms in middle age presents a diagnostic challenge, particularly when differentiating between a primary psychiatric disorder and an early neurodegenerative disease. The discrepancy between bedside clinical diagnosis and subsequent neuropathological findings in such cases further highlights the difficulty of accurately predicting pathology, especially when there are no evident focal lesions or changes in brain volume. Here we present the case of a 59-year-old woman with inconclusive neuroimaging who exhibited pronounced neuropsychiatric and behavioral symptoms initially suggestive of a mood disorder, then of behavioral variant frontotemporal dementia. However, upon autopsy, we identified coexisting Lewy body disease pathology and tau-related changes, including argyrophilic grain disease and primary age–related tauopathy. This case illustrates the challenges encountered when diagnosing late-onset neuropsychiatric symptoms, emphasizes the link between such symptoms and early-onset dementia and argyrophilic grain disease, and contributes to our understanding of the impact of mixed neuropathology in this population. Accurate diagnosis is essential for the development of molecular-specific therapies and, as well as for accurate prognosis and enrollment in clinical trials.

Practical exploration of BOPPPS model combined with situational teaching method in clinical training of intensive medicine: novel pedagogy and perception

ObjectiveTo explore the application value of bridge-in, learning objective, pre-assessment, participatory learning, post-assessment, and summary (BOPPPS) model combined with situational teaching method in the clinical teaching of intensive care unit (ICU), and to provide experience for the reform of ICU clinical teaching and standardized training of intensive medicine.MethodsA randomized trial was conducted using a multi-center, prospective cohort study. A total of 293 residential physicians in ICU of Fujian Medical University Union Hospital, the Affiliated Hospital of Putian University and the First Affiliated Hospital of Gannan Medical University from January 2021 to December 2023 were selected as subjects, and the residential physicians in ICU in each medical center were divided into control group and experimental group using random number table method. The control group adopted bedside teaching and demonstration teaching method, and the experimental group adopted BOPPPS model combined with situational teaching method. Clinical teaching performance was evaluated by ICU admission examination, and study process questionnaire (SPQ) and the critical thinking disposition inventory-Chinese version (CTDI-CV) was used to evaluate the learning motivation and critical thinking ability of the two groups. At the same time, the effect evaluation and satisfaction questionnaire of ICU training (EESQ) was used to evaluate the teaching satisfaction.ResultsThe scores of the experimental group in ICU theoretical knowledge, clinical thinking and skills, and the treatment of clinical critical cases were higher than those of the control group [(87.31 ± 13.15), (92.86 ± 12.35), (81.45 ± 11.28)] vs. [(83.94 ± 12.73), (88.37 ± 12.61), (78.83 ± 10.47)], the difference between the two groups was statistically significant (p < 0.05). The scores of surface motivation, deep motivation, achievement motivation and SPQ total scores of the experimental group were all higher than those in control group (p < 0.05), and the scores of seek truth, open mind, analytical ability, systematic ability, self-confidence of critical thinking and intellectual curiosity of the experimental group were also higher than those in the control group, and the CTDI total score was statistically significant (p < 0.05). In addition, the results of the questionnaire showed that the experimental group was better than the control group in terms of learning interest in ICU, improvement of humanistic care and doctor-patient communication ability, improvement of teamwork ability, improvement of job identity, ICU training harvest and satisfaction with teacher style (p < 0.05).ConclusionThe combination of BOPPPS model and situational teaching method is likely a more effective and helpful which may improve the clinical comprehensive ability and training quality of residential physicians, and it may be worth learning and promoting.

Unveiling the silent information of wastewater-based epidemiology of SARS-CoV-2 at community and sanitary zone levels: experience in Córdoba City, Argentina

ABSTRACT The emergence of COVID-19 in 2020 significantly enhanced the application of wastewater monitoring for detecting SARS-CoV-2 circulation within communities. From October 2021 to October 2022, we collected 406 wastewater samples weekly from the Córdoba Central Pipeline Network (BG-WWTP) and six specific sewer manholes from sanitary zones (SZs). Following WHO guidelines, we processed samples and detected SARS-CoV-2 RNA and variants using real-time PCR. Monitoring at the SZ level allowed for the development of a viral activity flow map, pinpointing key areas of SARS-CoV-2 circulation and tracking its temporal spread and variant evolution. Our findings demonstrate that wastewater-based surveillance acts as a sensitive indicator of viral activity, detecting imminent increases in COVID-19 cases before they become evident in clinical data. This study highlights the effectiveness of targeted wastewater monitoring at both municipal and SZ levels in identifying viral hotspots and assessing community-wide circulation. Importantly, the data shows that environmental wastewater studies provide valuable insights into virus presence, independent of clinical COVID-19 case records, and offer a robust tool for adapting to future public health challenges.